1. Unnecessary capsulotomy due to a missed diagnosis of Vitreous opacities Scott Geller MD Fort Myers Florida

2. I have no commercial relationships or financial interests Scott Geller MD Fort Myers Florida this is considered an off label use

3. Small Case Series retrospective analysis of 10 patients 2007 - 2009 all had complaints of blurred vision not resolved after laser capsulotomy Scott Geller MD Fort Myers Florida

4. usual complaint to ophthalmologist: ‘my vision gets blurred’ ‘when I read it gets blurry’ ‘something’s blurring my vision Scott Geller MD Fort Myers Florida

5. Patient parameters age range 53 - 76 co-morbidities: 1 prior RD w scleral buckle 6 R eyes 4 L eyes 2 multi-focal implants all had well done laser capsulotomies Scott Geller MD Fort Myers Florida

6. all patient 20/30 or better acuity patient has no other obvious corneal, retinal, or optic nerve pathology patient does not express typical eye floater complaints or symptoms Ophthalmologist assumes there must be some capsular problem Scott Geller MD Fort Myers Florida

7. Ophthalmologist performs a capsulotomy Patient reports no improvement in symptoms Patient is subjected to the ‘usual’ battery of unnecessary tests Patient referred/seeks opinion of other specialists.....often with no firm answer

8. patient loses faith in treating ophthalmologist finally gets a definitive diagnosis patient told ‘live with it’ extreme frustration because MD doesn’t appreciate severity of patient’s problem Scott Geller MD Fort Myers Florida

9. Correct diagnosis: patient history is key Patients often can not articulate the exact nature of the symptoms Physician can guide the patient in the history Materials and Methods ten cases Scott Geller MD Fort Myers Florida

10. Is the blur intermittent or constant ? What makes the symptoms better? Can patient duplicate symptoms merely by moving the head or eyes? Scott Geller MD Fort Myers Florida

11. Accurate history Undilated initial evaluation by MD Demonstration of worst acuity with opacity in visual axis- explain so patient understands Evaluate vitreous with Goldmann Lens Sophisticated devices are not needed Materials & Methods Scott Geller MD Fort Myers Florida

12. Lasag Microruptor II Yag laser Fundamental ( vs. Multi ) Mode Lasag/Haag- Streit CGV contact glass Initial energy 300 - 400 pulses 4-5 mJ 1 drop Pred Acetate, Fibruprofin gtts. 8x/d Scott Geller MD Fort Myers Florida

13. Treatment Parameters average number of sessions: 4.4 average total pulses: 1554 total power input: 5488 mJ average power/pulse: 3.5 mJ Scott Geller MD Fort Myers Florida

14. Results of 10 Patients No complications Results are subjective 3 Grades: mild, moderate, significant Scott Geller MD Fort Myers Florida

15. Key to Accuracy & Success Listen to the Patient !! Scott Geller MD South Florida Eye Foundation Fort Myers Florida